MP64-09 PROSPECTIVE ANALYSIS OF TUMOR GROWTH RATES BASED ON PATIENT COMORBIDITIES AND IMAGING CHARACTERISTICS FROM THE DISSRM REGISTRY: IMPLICATIONS FOR FUTURE NEPHRON-SPARING SURGERY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized V1 Apr 2014MP64-09 PROSPECTIVE ANALYSIS OF TUMOR GROWTH RATES BASED ON PATIENT COMORBIDITIES AND IMAGING CHARACTERISTICS FROM THE DISSRM REGISTRY: IMPLICATIONS FOR FUTURE NEPHRON-SPARING SURGERY Phillip Pierorazio, Mark Ball, Matthew Danzig, Rashed Ghandour, Peter Chang, Robert Hartman, Andrew Wagner, James McKiernan, and Mohamad Allaf Phillip PierorazioPhillip Pierorazio More articles by this author , Mark BallMark Ball More articles by this author , Matthew DanzigMatthew Danzig More articles by this author , Rashed GhandourRashed Ghandour More articles by this author , Peter ChangPeter Chang More articles by this author , Robert HartmanRobert Hartman More articles by this author , Andrew WagnerAndrew Wagner More articles by this author , James McKiernanJames McKiernan More articles by this author , and Mohamad AllafMohamad Allaf More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1926AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) is a management option for patients with small renal masses (SRM). Retrospective data indicates that patient and tumor characteristics may influence the likelihood of benign, indolent and malignant pathology. We hypothesize that tumor kinetics and growth rate (GR) may also be mitigated by patient comorbidities or initial tumor characteristics. We therefore examined the prospective, multi-institutional Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) Registry, opened January 1, 2009, enrolling patients with SRM ≤4.0 cm undergoing AS. METHODS Patients were enrolled following consultation and choice of AS or intervention. Those electing AS followed an imaging protocol every 4-6 months for 2 years, then every 6-12 months for 3 years. The last GR was calculated for each patient as the linear change in greatest tumor diameter over time since initial imaging. Univariable linear regression modeling was used to determine patient and tumor characteristics predictive of GR at last follow-up. RESULTS Of 177 patients initially undergoing AS, 95 had their most recent follow-up imaging at a median of 643 days (range 64-1647). Median growth rate was 0.156 cm/year (range -1.81-2.5). Obesity was the only patient characteristic predictive of GR (Coefficient -0.355, p=0.02); neither age, sex, ECOG, Charlson Comorbidity Index nor any individual comorbidity predicted GR. Tumor size at initial imaging did not predict GR; however, enhancement in the nephrogenic (venous) phase of CT scan (Coef. 0.017, p=0.024) and hilar tumors (Coef. 0.293, p=0.035) predicted GR; nearness to the collecting system (p=0.057) and tumors crossing polar lines (p=0.08) by RENAL Nephrometry were suggestive of GR. CONCLUSIONS Patient and tumor characteristics may have implications for tumor growth kinetics in patients undergoing AS for SRM. Consideration of these factors may be important in the choice of AS and may influence the timing of intervention in order to preserve an opportunity for nephron-sparing surgery. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e704 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Phillip Pierorazio More articles by this author Mark Ball More articles by this author Matthew Danzig More articles by this author Rashed Ghandour More articles by this author Peter Chang More articles by this author Robert Hartman More articles by this author Andrew Wagner More articles by this author James McKiernan More articles by this author Mohamad Allaf More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...